Choosing New Health Insurance

We have spent hours this month investigating our health insurance options.

Since my husband began working at his current company 12 years ago we've had the same insurance. Until now, his company contracted with one insurance company, offering 3-4 plan levels each year. When he began employment there, we chose a plan with a lower deductible, lower coinsurance costs and a lower out-of-pocket maximum. And, of course, a higher monthly price. The per paycheck cost and copays went up a few times, but the coverage remained essentially the same. We glanced at open enrollment paperwork every year, but never considered changing.

This year the company rolled out a completely new system, with choices!!! There are now plans available from 3 different insurance companies, so that, including the various levels of coverage, there were a total of 15 options to consider. Fifteen.

The idea is that each contracted insurance company offers 3-4 levels of plans. The levels are equivalent across insurers. so, for example, the 'gold plan' from each insurance company includes a $20 primary care visit copay, 80% coverage for hospitalization, and $8 monthly copays for tier 1 medicines.

Speaking of pharmacy benefits, also new is that those will now be through the health insurer we choose. For several years now, the employer has contracted with Caremark for drug benefits instead of them coming through the health insurer. And the coverage was excellent. Now we have to factor coverage for insulin, test strips, and other family members' medicines into the health insurance choice.

Our initial instinct was to look into the plans from our current insurer. The devil you know is better than the devil you don't, right? There's a plan with coverage similar to what we have now. We double checked some things, like making sure the deductible was about the same and that the coverage for pump supplies seemed equivalent. We knew our physicians probably participated but we double checked the key ones to be sure they were in this particular plan. Things looked good.

Problem was: that particular 'gold' plan costs about $5000 more per year than one offered through a different insurance company. For a few hundred or so per year I might have stuck with my 'devil you know...' philosophy and bit the bullet. For $5000 we were back to the drawing board.

And it looks like we're rolling the dice and trying a new insurance company this year.

Our doctors all participate. We'll pay more for insulin and supplies, but not anywhere near $5000 more. Humalog is the insulin of choice, with our current Novolog not covered on any tier of the formulary.  I'm worried that I'm unfamiliar with the culture and mechanics of this company, diabetes-wise, and that there will be unpleasant surprises. There will be lots of things to try to get covered this year, with an inevitable switch away from Animas supplies and a possible switch in CGM sensors as well.

But on paper it looks reasonable enough to try in order to save thousands of dollars. I'll let you know how it goes...



via Adventures in Diabetes Parenting